NR511
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and
red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive
itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no
decrease in extraocular movements. The patient has a sibling that just started day care recently. He also
has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis?
1.Viral conjunctivitis.
2.Bacterial conjunctivitis.
3.Allergic conjunctivitis.
4.Blepharitis. - ANSWER✅✅✅1.
Viral conjunctivitis.
A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains
of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of
100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa
and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar
exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear
lung exam. What is his most likely diagnosis?
1.
Viral pharyngitis.
2.
Mononucleosis.
3.
Streptococcal pharyngitis.
4.
Upper respiratory infection. - ANSWER✅✅✅2.
Mononucleosis.
A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow
musicians at the end of a night of performing, a problem that is compounded by the noisy environment
of the club. These symptoms are most characteristic of which of the following?
1.
Sensorineural loss.
,NR511
2.
Conductive loss.
3.
Tinnitus.
4.
Vertigo. - ANSWER✅✅✅1.
Sensorineural loss.
A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2
days. He states there is a streak of bright blood along his stool every time he has a bowel movement.
The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no
abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test
but has no noticeable rectal bleeding or lesions. What is the likely diagnosis?
1.Internal hemorrhoid.
2.External hemorrhoid.
3.Bleeding peptic ulcer.
4.Rectal fissure. - ANSWER✅✅✅1.
Internal hemorrhoid
A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark
area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus,
drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's
sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear
and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best
treatment?
1.
Topical steroids and close follow-up with an ophthalmologist.
2.
Sending the patient to the emergency department for immediate ophthalmology consult.
3.
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
4.
,NR511
Cold compresses and frequent handwashing. - ANSWER✅✅✅3.
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal
region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past
several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less
severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is
unclear as to a precipitating event but notes that he has had visual disturbances before each headache
and he has been under a lot of stress in his job. Based on this description, what is the most likely
diagnosis of this type of headache?
1.
Tension.
2.
Migraine.
3.
Cluster.
4.
Temporal arteritis. - ANSWER✅✅✅2.
Migraine.
A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is
diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively
worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his
pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he
scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms?
1.Botulism.
2.Salmonella.
3Lyme disease.
4.Vitamin C deficiency. - ANSWER✅✅✅1.
Botulism.
, NR511
A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has
associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110,
blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient?
1.Sigmoidoscopy.
2.Abdominal series.
3.Computed tomography (CT) scan with oral contrast.
4.Abdominal ultrasound. - ANSWER✅✅✅3.
Computed tomography (CT) scan with oral contrast.
A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal
reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without
improvement of her symptoms. What is the next step in management of this patient's GERD?
1.Order an endoscopy.
2.Order a Helicobacter pylori blood test.
3.Try adding ranitidine to the patient's regimen.
4.Try adding bismuth to the patient's regimen. - ANSWER✅✅✅1.
Order an endoscopy.
A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3
days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2
nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the
patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile
with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no
mastoid tenderness. What is the next step?
1.
Symptom management and reassurance that symptoms will resolve with time.
2.
Computed tomography (CT) of the head.
3.
Amoxicillin 80 to 90 mg/kg/d.
4.
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and
red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive
itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no
decrease in extraocular movements. The patient has a sibling that just started day care recently. He also
has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis?
1.Viral conjunctivitis.
2.Bacterial conjunctivitis.
3.Allergic conjunctivitis.
4.Blepharitis. - ANSWER✅✅✅1.
Viral conjunctivitis.
A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains
of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of
100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa
and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar
exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear
lung exam. What is his most likely diagnosis?
1.
Viral pharyngitis.
2.
Mononucleosis.
3.
Streptococcal pharyngitis.
4.
Upper respiratory infection. - ANSWER✅✅✅2.
Mononucleosis.
A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow
musicians at the end of a night of performing, a problem that is compounded by the noisy environment
of the club. These symptoms are most characteristic of which of the following?
1.
Sensorineural loss.
,NR511
2.
Conductive loss.
3.
Tinnitus.
4.
Vertigo. - ANSWER✅✅✅1.
Sensorineural loss.
A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2
days. He states there is a streak of bright blood along his stool every time he has a bowel movement.
The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no
abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test
but has no noticeable rectal bleeding or lesions. What is the likely diagnosis?
1.Internal hemorrhoid.
2.External hemorrhoid.
3.Bleeding peptic ulcer.
4.Rectal fissure. - ANSWER✅✅✅1.
Internal hemorrhoid
A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark
area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus,
drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's
sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear
and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best
treatment?
1.
Topical steroids and close follow-up with an ophthalmologist.
2.
Sending the patient to the emergency department for immediate ophthalmology consult.
3.
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
4.
,NR511
Cold compresses and frequent handwashing. - ANSWER✅✅✅3.
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal
region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past
several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less
severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is
unclear as to a precipitating event but notes that he has had visual disturbances before each headache
and he has been under a lot of stress in his job. Based on this description, what is the most likely
diagnosis of this type of headache?
1.
Tension.
2.
Migraine.
3.
Cluster.
4.
Temporal arteritis. - ANSWER✅✅✅2.
Migraine.
A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is
diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively
worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his
pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he
scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms?
1.Botulism.
2.Salmonella.
3Lyme disease.
4.Vitamin C deficiency. - ANSWER✅✅✅1.
Botulism.
, NR511
A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has
associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110,
blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient?
1.Sigmoidoscopy.
2.Abdominal series.
3.Computed tomography (CT) scan with oral contrast.
4.Abdominal ultrasound. - ANSWER✅✅✅3.
Computed tomography (CT) scan with oral contrast.
A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal
reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without
improvement of her symptoms. What is the next step in management of this patient's GERD?
1.Order an endoscopy.
2.Order a Helicobacter pylori blood test.
3.Try adding ranitidine to the patient's regimen.
4.Try adding bismuth to the patient's regimen. - ANSWER✅✅✅1.
Order an endoscopy.
A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3
days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2
nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the
patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile
with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no
mastoid tenderness. What is the next step?
1.
Symptom management and reassurance that symptoms will resolve with time.
2.
Computed tomography (CT) of the head.
3.
Amoxicillin 80 to 90 mg/kg/d.
4.
